<p>Switch Rates and Total Cost of Care Associated with Apremilast and Biologic Therapies in Biologic-Naive Patients with Plaque Psoriasis</p>

Abstract

Purpose Compare treatment switching rates and costs among biologic-naive psoriasis patients initiating apremilast or biologics. Methods This retrospective claims analysis used IBM MarketScan Commercial and Medicare Supplemental databases to identify patients who initiated apremilast or a biologic (ie, tumor necrosis factor [TNF] or interleukin [IL] inhibitor) for psoriasis treatment between January 1, 2015, and December 31, 2016. A 1:1 propensity score matching was used to adjust for possible selection bias and maximize the number of patients available for analysis. Treatment switching, days to switch, and healthcare costs were assessed at 12 months. T -test and chi-square test were used to evaluate differences between cohorts for continuous and categorical variables as appropriate; Wilcoxon rank-sum tests were used to assess cost differences. Results In total, 88,025 patients newly initiated apremilast, a TNF inhibitor, or an IL inhibitor. After inclusion/exclusion criteria were applied and patients were propensity score matched, 1645 (apremilast), 1207 (TNF inhibitor), and 438 (IL inhibitor) patients were included in this analysis. Twelve-month switch rates were significantly lower for apremilast initiators compared with TNF inhibitor initiators (14% vs 25%; p<0.01) and comparable to IL inhibitors (14% vs 11%; p>0.05). No statistical difference was observed in days to switch at 12 months for any treatment group. Total healthcare costs were lower for apremilast initiators compared with TNF and IL inhibitor initiators ($34,028 vs $55,973 and $64,430; p<0.0001). Per-patient per-month (PPPM) costs were significantly lower for apremilast initiators compared with TNF inhibitor and IL inhibitor initiators ($2834 vs $4662 and $5366; p<0.0001). Conclusion Over a 12-month follow-up, biologic-naive psoriasis patients initiating apremilast had significantly lower switching rates compared with patients on TNF inhibitors and similar rates as patients on IL inhibitors. PPPM and total healthcare costs were significantly lower for patients initiating apremilast vs TNF or IL inhibitors, primarily due to lower pharmacy costs.

Treatment patterns, healthcare resource utilization, and costs in patients with moderate‐to‐severe psoriasis treated with systemic therapy in Japan: A retrospective claims database study

“…In this study, among patients who persisted with index treatment at 12 months, treatment costs associated with biologics were greater than those receiving oral systemic treatments, an anticipated finding that has also been reported in other studies 39,40 . Moreover, the cost associated with biologics ranged from JPY 2.2 to 3.2 million (approximately USD 17000 to 25 000) per patient per year, consistent with a previous finding using similar data from the JMDC database, for the period between 2009 and 2016 24 .…”

“…Biologics constituted the most common second-line therapy for patients previously initiated on PDE-4 inhibitor, leading to an increase in cost by JPY 45102 (approximately USD 364) PPPM. Consistent with previous studies,39,40 switching from oral systemic treatments to biologics can significantly raise treatment expenditure because the medical cost associated with biologic treatments is greater than that for oral systemic treatments. The economic burden of treatment switching may have precluded patients from seeking alternative therapies after discontinuation of their index therapy.…”

Switch rates and total cost associated with apremilast and biologics in biologic-naive patients with psoriatic arthritis

“…We conducted a retrospective analysis using the IBM MarketScan R Commercial and Medicare Supplemental databases (IBM Watson Health, MA, USA) to identify two cohorts of biologic-naive patients with PsA: patients who initiated apremilast and patients who initiated a biologic agent for the treatment of PsA between 1 January 2015 and 31 December 2016. A similar retrospective study was carried out for patients with psoriasis but without PsA who received treatment [20].…”

Suboptimal Clinical and Quality of Life Outcomes in Patients with Psoriasis Undertreated with Oral Therapies: International Physician and Patient Survey

“…The results of this study largely align with the published literature. Previously reported rates of switching vary in magnitude and methodology, with claims-based database analyses reporting 12-month medication switch rates ranging from 14% [ 15 , 16 ] to 30% [ 17 ] for oral therapies and 7% [ 15 ] to 27% [ 17 , 18 ] for biologics. This study adds treatment switching stratified by the type of oral medication and country to the general knowledge base.…”